AB995: Bill Text

AB995,37,9 456.02 (6) In cooperation with other agencies and appropriate organizations, conduct a continuing study of the practice of nursing home administration within the state with a view to the improvement of the standards imposed for the licensing of such nursing home administrators and of procedures and methods for the enforcement of such the standards under sub. (1) with respect to nursing home administrators of nursing homes who have been licensed as such; under this chapter.

AB995, s. 76 Section 76. 456.02 (7) of the statutes is amended to read:

AB995,37,19 456.02 (7) Develop and enforce standards for the Promulgate rules establishing supervised practical experience to be required requirements that, except as provided in s. 456.04 (2m), an individual shall satisfy before being allowed to take an examination for licensure; and as a nursing home administrator. Except as provided in s. 456.04 (2m), the rules shall require the individual to complete at least 2,000 hours in any consecutive 3-year period within the 5-year period immediately preceding the date of application for examination in an internship, administrator-in-training program, or any other structured program approved by the examining board.

AB995, s. 77 Section 77. 456.04 (intro.) (except 456.04 (title)) of the statutes is renumbered 456.04 (1m) (intro.) and amended to read:

AB995,37,24 456.04 (1m) (intro.) The Except as provided in sub. (2m), the examining board shall allow any person to take the examination for licensure as a nursing home administrator who satisfies all of the following requirements:

AB995, s. 78 Section 78. 456.04 (1) of the statutes is renumbered 456.04 (1m) (a).

AB995, s. 79 Section 79. 456.04 (1m) (d) of the statutes is created to read:

AB995,38,2 456.04 (1m) (d) Has one of the following:

AB995,38,4 1. A bachelor's, master's, or doctoral degree with a major in health care administration or long-term care from an accredited college or university.

AB995,38,7 2. A bachelor's degree in any field from an accredited college or university and completion of a specialized course that the examining board determines is adequate preparation for nursing home administration.

AB995, s. 80 Section 80. 456.04 (1m) (e) of the statutes is created to read:

AB995,38,10 456.04 (1m) (e) Satisfies the supervised practical experience requirements specified in the rules promulgated under s. 456.02 (7).

AB995, s. 81 Section 81. 456.04 (2) of the statutes is renumbered 456.04 (1m) (b).

AB995, s. 82 Section 82. 456.04 (2m) of the statutes is created to read:

AB995,38,15 456.04 (2m) The examining board shall allow a person to take the examination for licensure as a nursing home administrator if he or she satisfies the requirements specified in sub. (1m) (a), (b), and (c) and all of the following are satisfied:

AB995,38,20 (a) The person was enrolled, at any time within the 2-year period before the effective date of this paragraph .... [revisor inserts date], in a regular course of study or equivalent specialized courses or a program of study that the examining board considered adequate academic preparation for nursing home administration under s. 456.04 (4), 2001 stats.

AB995,38,23 (b) No later than 2 years after the effective date of this paragraph .... [revisor inserts date], the person completes the regular course of study, specialized courses, or program of study specified in par. (a).

AB995,39,4 (c) If the person was enrolled, at any time within the 2-year period before the effective date of this paragraph .... [revisor inserts date], in specialized courses or a program of study specified in par. (a), the person completes, no later than 2 years after the effective date of this paragraph .... [revisor inserts date], one year of supervised practical experience as specified in rules promulgated by the examining board.

AB995,39,9 (d) If the person was enrolled, at any time within the 2-year period before the effective date of this paragraph .... [revisor inserts date], in a regular course of study specified in par. (a), the person completes, no later than 2 years after the effective date of this paragraph .... [revisor inserts date], a supervised clinical practicum as specified in rules promulgated by the examining board.

AB995, s. 83 Section 83. 456.04 (3) of the statutes is renumbered 456.04 (1m) (c).

AB995, s. 84 Section 84. 456.04 (4) of the statutes is repealed.

AB995, s. 85 Section 85. 456.08 of the statutes is renumbered 456.08 (intro.) and amended to read:

AB995,39,19 456.08 Reciprocity. (intro.) The examining board may grant a nursing home administrator license under this chapter to a person an applicant who holds a current nursing home administrator license issued by the proper authorities of any other state or licensing jurisdiction, upon payment of the fee specified in s. 440.05 (2) and upon submission of satisfactory evidence of the person's qualifications. evidence satisfactory to the examining board that the applicant satisfies each of the following:

AB995, s. 86 Section 86. 456.08 (1), (2), (3) and (4) of the statutes are created to read:

AB995,39,23 456.08 (1) The applicant has a bachelor's degree in any field or holds a current certification as a nursing home administrator granted by the American College of Health Care Administrators.

AB995,40,3 (2) The applicant has practiced as a nursing home administrator in good standing for at least 2,000 hours in any consecutive 3-year period within the 5-year period immediately preceding the date of application.

AB995,40,5 (3) Subject to ss. 111.321, 111.322, and 111.335, the applicant does not have an arrest or conviction record.

AB995,40,8 (4) The applicant has passed an examination approved by the examining board relating to state and federal laws governing the practice of nursing home administration.

AB995, s. 87 Section 87. 456.09 (1) (c) of the statutes is amended to read:

AB995,40,13 456.09 (1) (c) Practice Except as provided in s. 456.12, practice as a nursing home administrator or use in connection with his or her name any title or designation tending to imply that the person is a nursing home administrator unless duly licensed and registered to so practice under this chapter; or

AB995, s. 88 Section 88. 456.12 of the statutes is created to read:

AB995,40,20 456.12 Exemption. This chapter does not apply to a person who acts in the capacity of an administrator of a nursing home operated by adherents of a church or religious denomination which subscribes to the act of healing by prayer and the principles of which do not include medical treatment, if the person does not use in connection with his or her name any title or designation tending to imply that the person is a nursing home administrator.

AB995, s. 89 Section 89. 609.22 (2) of the statutes is amended to read:

AB995,40,25 609.22 (2) Adequate choice. A defined network plan that is not a preferred provider plan shall ensure that, with respect to covered benefits, each enrollee has adequate choice among participating providers and that the providers are, to the extent consistent with s. 628.36 (2) (b) 3. and (2m), accessible and qualified.

AB995, s. 90 Section 90. 609.32 (2) (a) of the statutes is amended to read:

AB995,41,10 609.32 (2) (a) A defined network plan shall develop , consistent with s. 628.36 (2) (b) 3. and (2m), a process for selecting participating providers, including written policies and procedures that the plan uses for review and approval of providers. After consulting with appropriately qualified providers, the plan shall establish, to the extent consistent with s. 628.36 (2) (b) 3. and (2m), minimum professional requirements for its participating providers. The process for selection shall include verification of a provider's license or certificate, including the history of any suspensions or revocations, and the history of any liability claims made against the provider.

AB995, s. 91 Section 91. 628.36 (1) of the statutes is renumbered 628.36 (1m) and amended to read:

AB995,41,16 628.36 (1m) Payment methods. Any corporation operating a voluntary health care plan may pay health care professionals on a salary, per patient , or fee-for-service basis to provide health care to policyholders or beneficiaries of the corporation.

AB995, s. 92 Section 92. 628.36 (1c) (intro.) of the statutes is created to read:

AB995,41,18 628.36 (1c) Definitions. (intro.) In this section:

AB995, s. 93 Section 93. 628.36 (2) (a) (intro.) of the statutes is amended to read:

AB995,41,20 628.36 (2) (a) (intro.) In this section subsection:

AB995, s. 94 Section 94. 628.36 (2) (b) 3. of the statutes is amended to read:

AB995,41,25 628.36 (2) (b) 3. Except as provided in subd. subds. 4. and 4m., and subject to sub. (2m) (e), no provider may be denied the opportunity to participate in a health care plan, other than a health maintenance organization, a limited service health organization or a preferred provider plan, under the terms of the plan.

AB995, s. 95 Section 95. 628.36 (2) (b) 4. of the statutes is amended to read:

AB995,42,5 628.36 (2) (b) 4. Any health care plan may exclude a provider from participation in the health care plan for cause related to the practice of his or her profession. A health care plan that excludes a provider from participation shall advise the provider in writing of the reason for the exclusion.

AB995, s. 96 Section 96. 628.36 (2) (b) 4m. of the statutes is created to read:

AB995,42,10 628.36 (2) (b) 4m. Subdivision 3. applies to a health maintenance organization, limited service health organization, or preferred provider plan only with respect to a provider located in the geographic service area of the health maintenance organization, limited service health organization, or preferred provider plan.

AB995, s. 97 Section 97. 628.36 (2m) (title) of the statutes is repealed and recreated to read:

AB995,42,12 628.36 (2m) (title) Annual participation election period.

AB995, s. 98 Section 98. 628.36 (2m) (a) (intro.) and 2m. of the statutes are consolidated, renumbered 628.36 (2m) (ac) and amended to read:

AB995,42,17 628.36 (2m) (ac) In this subsection: 2m. "Pharmaceutical, "health care services" do not include the administration of a drug product or device or vaccine under s. 450.035.

AB995, s. 99 Section 99. 628.36 (2m) (a) 1. of the statutes is renumbered 628.36 (1c) (a).

AB995, s. 100 Section 100. 628.36 (2m) (a) 2. of the statutes is renumbered 628.36 (1c) (b).

AB995, s. 101 Section 101. 628.36 (2m) (a) 3. of the statutes is renumbered 628.36 (1c) (c).

AB995, s. 102 Section 102. 628.36 (2m) (e) 1. of the statutes is amended to read:

AB995,43,8 628.36 (2m) (e) 1. A health maintenance organization, limited service health organization, or preferred provider plan that provides coverage of pharmaceutical health care services when that are performed by one or more pharmacists health care professionals who are selected by the organization or plan but who are not full-time salaried employees or partners of the organization or plan shall provide an annual period of at least 30 days during which any pharmacist registered under ch. 450 health care professional who provides those health care services, who has been granted a credential, as defined in s. 440.01 (2) (a), to practice in this state, and who is located in the geographic service area of the organization or plan may elect to participate in the health maintenance organization, limited service health organization, or preferred provider plan under its terms as a selected provider for at least one year.

AB995, s. 103 Section 103. 628.36 (2m) (e) 2. of the statutes is amended to read:

AB995,43,14 628.36 (2m) (e) 2. Except as provided in subd. 3., subd. 1. applies to health maintenance organizations on and after May 10, 1984. Except as provided in subd. 4., subd. 1. applies to, limited service health organizations, and preferred provider plans on or after April 28, 1990 the effective date of this subdivision .... [revisor inserts date].

AB995, s. 104 Section 104. 628.36 (2m) (e) 3. of the statutes is amended to read:

AB995,43,23 628.36 (2m) (e) 3. If compliance with the requirements of subd. 1. during the period specified in subd. 2. would impair any provision of a contract between a health maintenance organization, limited service health organization, or preferred provider plan and any other person, and if the contract provision was in existence prior to May 10, 1984 the effective date of this subdivision .... [revisor inserts date], then immediately after the expiration of all such contract provisions the health maintenance organization, limited service health organization, or preferred provider plan shall comply with the requirements of subd. 1.

AB995, s. 105 Section 105. 628.36 (2m) (e) 4. of the statutes is repealed.

AB995, s. 106 Section 106. 628.36 (3) of the statutes is amended to read:

AB995,44,9 628.36 (3) Exemption by rule. By rule the commissioner may exempt from the application of any part of subs. (1) (1m) to (2m) plans which that provide innovative approaches to the delivery of health care or which that are designed to contain health care costs, and which that cannot operate successfully consistent with all of the provisions in subs. (1) (1m) to (2m). The commissioner may promulgate such a rule only if on a finding that the interests of the public require such plans as an experiment, to supply health care services that are not otherwise available in adequate quantity or quality, or to contain health care costs. The promulgated rule shall be as narrow as is compatible with the success of the plans.

AB995, s. 107 Section 107. 632.89 (1) (am) of the statutes is created to read:

AB995,44,12 632.89 (1) (am) "Consumer price index" means the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.

AB995, s. 108 Section 108. 632.89 (1) (b) of the statutes is created to read:

AB995,44,16 632.89 (1) (b) "Diagnostic testing" means procedures used to exclude the existence of conditions other than nervous or mental disorders or alcoholism or other drug abuse problems.

AB995, s. 109 Section 109. 632.89 (2) (b) 1. of the statutes is amended to read:

AB995,44,23 632.89 (2) (b) 1. Except as provided in subd. 2., if a group or blanket disability insurance policy issued by an insurer provides coverage of inpatient hospital treatment or outpatient treatment or both, the policy shall provide coverage in every policy year as provided in pars. (c) to (dm), as appropriate, except that the total coverage under the policy for a policy year need not exceed $7,000 $16,800 or the equivalent benefits measured in services rendered.

AB995, s. 110 Section 110. 632.89 (2) (c) 2. b. of the statutes is amended to read:

AB995,45,5 632.89 (2) (c) 2. b. Seven thousand Sixteen thousand eight hundred dollars minus any applicable cost sharing at the level charged under the policy for inpatient hospital services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $6,300 $15,100 in equivalent benefits measured in services rendered.

AB995, s. 111 Section 111. 632.89 (2) (d) 2. of the statutes is amended to read:

AB995,45,11 632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $2,000 $3,100 minus any applicable cost sharing at the level charged under the policy for outpatient services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $1,800 $2,800 in equivalent benefits measured in services rendered.

AB995, s. 112 Section 112. 632.89 (2) (dm) 2. of the statutes is amended to read:

AB995,45,18 632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $3,000 $4,600 minus any applicable cost sharing at the level charged under the policy for transitional treatment arrangements or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $2,700 $4,100 in equivalent benefits measured in services rendered.

AB995, s. 113 Section 113. 632.89 (2) (f) of the statutes is created to read:

AB995,45,23 632.89 (2) (f) Report on coverage limits. The department of health and family services shall report annually to the governor and the legislature on revising the coverage limits specified in this subsection based on the change in the consumer price index for medical costs.

AB995, s. 114 Section 114. 632.89 (6) and (7) of the statutes are created to read:

AB995,46,3 632.89 (6) Prescription drugs and diagnostic testing. (a) The coverage amounts specified in sub. (2) shall not include costs incurred for prescription drugs or diagnostic testing.

AB995,46,5 (b) The department of health and family services may specify, by rule, the diagnostic testing procedures to which par. (a) applies.

AB995,46,8 (7) Treatment of costs. The coverage amounts specified in sub. (2) apply to actual payments or reimbursements made by an insurer if the payment or reimbursement amounts are less than the amounts charged by a provider.

AB995, s. 115 Section 115. 895.48 (1m) of the statutes, as affected by 2003 Wisconsin Act 33, is renumbered 895.48 (1m) (a).

AB995, s. 116 Section 116. 895.48 (1m) (b) of the statutes is created to read:

AB995,46,13 895.48 (1m) (b) This subsection does not apply to health care services provided by a volunteer health care provider under s. 146.89.

AB995, s. 117 Section 117 . Nonstatutory provisions.

AB995,46,18 (1) The department of health and family services shall submit in proposed form the rules required under section 46.03 (44) of the statutes, as created by this act, to the legislative council staff under section 227.15 (1) of the statutes no later than the first day of the 7th month beginning after the effective date of this subsection.

AB995, s. 118 Section 118 . Initial applicability.

AB995,46,22 (1) The treatment of section 49.688 (4r) of the statutes first applies to eligibility determinations made and deductible amounts paid on the effective date of this subsection.